The Affordable Care Act and regulation: Coverage effects of guaranteed issue and ratings reform

An important part of the Affordable Care Act (ACA) that has received relatively little research attention is regulatory reform in the small and non‐group markets, particularly guaranteed issue and rating restrictions. In order to identify the effect of this part of the ACA, I use states that already...

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Bibliographic Details
Published in:Health economics 2022-12, Vol.31 (12), p.2575-2592
Main Author: Baughman, Reagan A.
Format: Article
Language:English
Subjects:
Affordable Care Act
Age differences
community rating
guaranteed issue
Health care industry
Health economics
Health insurance
individual market
Insurance coverage
Medicaid
Ratings & rankings
Regulatory reform
small‐group market
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Summary:An important part of the Affordable Care Act (ACA) that has received relatively little research attention is regulatory reform in the small and non‐group markets, particularly guaranteed issue and rating restrictions. In order to identify the effect of this part of the ACA, I use states that already had these policies before 2014 as a control group for states newly exposed to them under the ACA. Overall, the reforms do not have any effect in states that expanded Medicaid but are associated with a 1.64 percentage point (or 2.16%) increase in the probability of having health insurance coverage in states that did not expand Medicaid. Effects are seen across broad age range, and are strongest for those whose incomes are slightly above the Medicaid threshold and qualify them for the highest Marketplace subsidy levels.
ISSN:1057-9230
1099-1050
DOI:10.1002/hec.4596